Two New York City hospitals are getting serious about childhood obesity by writing prescriptions for fruits and vegetables. But they’re not the only ones addressing the weighty problem in innovative ways.

Pediatricians at Lincoln Medical Center and Harlem Hospital are sending young children who visit the hospital for obesity treatment home with prescriptions to eat one more serving of fruits and vegetables each day. The Fruit and Vegetable Prescription (FVRx), a four month pilot program, allows the patients with prescriptions to get coupons for fresh produce at farmers markets and the city’s green carts.

With more pediatricians treating kids for diseases formerly only seen in adults, some hospitals, feeling pressure to address one of the leading causes of health problems in their communities, are taking the lead in finding better ways to encourage children to eat better and exercise more.

In Georgia, Children’s Healthcare of Atlanta realized the issue needed to be addressed more aggressively when a 2010 study, F is for Fat, found the state had the second highest childhood obesity rate in the U.S., behind only Mississippi, based on data from the National Child Health Survey.

Over 40% of Georgia’s children were clinically obese, meaning that about one million kids were facing potential medical crises, since early obesity can translate into chronic health problems in adulthood such as heart disease, diabetes, hypertension and joint conditions. Among its own patients, Children’s Healthcare of Atlanta, a pediatric hospital in Atlanta, learned that 75% of parents whose children were obese did not think their child had a problem. “I had pediatricians sending me these kids that had diabetes, high blood pressure, and were severely overweight for surgery,” says Dr. Mark Wulkan, the Surgeon in Chief at Children’s Healthcare of Atlanta who performs minimally invasive surgeries for weight loss on children and performed the first adolescent bariatric surgery. “But this isn’t something you do as a hobby. I kept saying, I am sorry I can’t [operate on them], but then I saw so many of them.”

One morbidly obese child who was referred to Wulkan had such severe sleep apnea that he needed a tracheostomy, or surgical incision into his windpipe, to help him breathe. “Do you know why he came in to get better? He came so he could swim. He hadn’t been swimming in years. Eventually, it just breaks your heart.”

Wulkan started a program in 2009 for his patients, called Health4Life, which now treats over 600 kids in Georgia who are in the 95th percentile for body mass index (BMI). But as one of the largest health care providers in the state, Children’s Healthcare of Atlanta also decided it had a responsibility to intervene.

That’s how Strong4Life, a comprehensive wellness program designed to treat obesity by addressing all aspects of a child’s environment, from school nutrition to doctor’s visits, was born. “At the time [the education effort] was controversial, because it called a spade a spade. But it got people talking about it and got us to where we are now, and that is that parent awareness [about childhood obesity] is closer to about 40%,” he says.

Other children’s hospitals across the country have been following suit, and more will likely take another look at what they can do to combat childhood obesity, especially after the American Medical Association redefined obesity as a disease in June. In 2008, the Child Policy Research Center indicated that 29.5% of kids in Washington were overweight or obese. Seattle Children’s Hospital now has several programs to address obesity–including a prescription program similar to that in New York, and will soon start offering pilot classes on nutrition for community members outside the hospital.

“We see obesity as a crisis that is real and preventable. For us it has been a journey in recognizing that we are a model and a leader in this,” says Paula Sword, the manager of the hospital’s Obesity Program. “That’s why in 2012 we removed sugar-sweetened beverages from our hospital. Leading by example is very important, and we continue to look at better ways to engage the community at large in healthy lifestyles. Obesity is a complex disease. It’s takes a multi-disciplinary team of registered dietitians, social workers, physicians and athletic trainers to address all the components.”

And to ensure that the lessons of healthy eating stay with children, the hospital is launching a pilot gardening program this year, turning a defunct helicopter landing pad into a community garden.

As more health care experts are realizing, healthy eating habits only make sense in environments that encourage and make such choices easy. That’s why officials at the Cleveland Clinic in Ohio have worked with schools to develop nutritional guidelines and launched a Community Farmers Market Program in 2008 to make fresh produce more accessible. “Fast food restaurants are closer than grocery stores to residential homes in the area surrounding Cleveland Clinic, making it difficult to make the right food choices,” says a hospital spokesperson.

The trend reflects the shifting role that hospitals play in the health of its communities; traditionally places where people went after they were sick, health care centers are increasingly expected to participate in preventing disease as well. But will these efforts cost them in the long run, by eliminating the very patients they need to survive? Dr. Toby Cosgrove, CEO and president of Cleveland Clinic, doesn’t think so. “There will always be patients for us to treat,” he says. They just won’t be suffering from conditions that are preventable with a healthy diet and lifestyle.

People have no idea what they are putting in their mouths.
They have no idea how many calories they should be eating, and the even less of
an idea of how many calories they ARE eating.

Let me be clear, if you are eating fast food more than once
a week, then you're very likely to be eating WAY TOO MANY calories per month.
It's very difficult to eat fast food or processed food from a grocery store and
still maintain an appropriate amount of calories.

@mtngoatjoe For more than 10 years, I have been a STRICT vegetarian. I am not overweight, never have been, have never smoked tobacco, nor anything else, and I don't touch illegal drugs, nor alcohol. I saw a physician a week ago for a checkup and he said my health is excellent. Now since I take care of myself, please tell me WHY I must be forced, basically at the point of a gun, to pay into OBAMACARE, where my hard-earned money will be used to pay for the medical treatment of obese slobs who are too lazy to take care of their own health, instead of being used to maintain my own health.

@eagle11772@mtngoatjoe Because you realize that, no matter how well you eat, there's still a random chance that you'll get cancer, or that you'll have a stroke when you're 70, or that your child will be born with a dangerous heart problem. And you realize that, without health insurance, any of those things, which are not caused by your actions, could easily bankrupt you. And you realize that for many people, their job doesn't provide either health insurance or enough money to buy it. And you realize that it's a moral right to make sure people don't die from the bad luck of getting a disease or condition which costs a lot of money to treat.

You can rant and rave all you want about this, and there's some truth in what you say: some diseases and conditions ARE made more likely due to lifestyle. And I understand why paying for those diseases annoys you. But even more health problems are not caused by anything in particular, and are mostly an effect of bad luck. When you say that you don't want to pay into Obamacare, you're not only saying that you don't think it's fair that you should have to pay for an obese person's diabetes, but also that you don't think it's fair to pay for an adult's broken leg or breast cancer, an elderly person's knee-replacement, or an infant's clef palate surgery.

@eagle11772Can you prevent accidents? Can you prevent other people from causing accidents that hurt you? Can you guarantee that you will NEVER get sick? How about your kids?

You can be as healthy as you can, but you can't stop the slow march of time, or the idiocy of others. Someday, you will need a doctor. And it's irresponsible of you to risk you life savings just because you live a healthy lifestyle.

@eagle11772@mtngoatjoe Also...the poor seem to struggle with obesity more. This might seem frustrating on the surface however there are reasons. Junk food is cheap food. You can get a 2 Liter soda..in dollar stores for 50 Cents. Boxed meals, that are $2-$3 dollars, ready to heat and eat-cheap and feed family of 4. America needs to talk about what we subsidize. Fruit and veggie growers get a "raw deal" comparable to high volume, cheap, mass ready made high calorie stuff.